Quality maternity care for every woman, everywhere: a call to action

This is the sixth and last paper in a Lancet Series about maternal health. It focuses on outlining five priority actions for the next five years to improve maternal health, in light of the findings of the five previous papers in the series.  Globally the maternal mortality ratio (MMR) nearly halved between 1990 and 2015, however it did not meet the 75% reduction called for by Millennium Development Goal 5.Sustainable Development Goal 3.1 calls for the global MMR to be reduced to less than 70 maternal deaths per 100,000 live births by 2030, with no individual country having a MMR higher than 140 per 100,000.Key points

• Three-quarters of women worldwide now deliver with a skilled birth attendant and two-thirds of women now access the recommended minimum of four antenatal care appointments
• However there is huge inequality between countries, for example a woman’s lifetime risk of dying as a result of pregnancy or childbirth is more than 100 times higher in sub-Saharan Africa than in high-income countries
• This exposes an important gap in quality of care: women are receiving delayed, inadequate, unnecessary, or even harmful services, which limits the health gains for mothers and babies
• In addition, millions of pregnant women and adolescents are still not able to access maternity care, despite huge international efforts
• Poor-quality and inaccessible care exists in all countries across the world, whether they are low, middle, or high income, and needs to be addressed

N.B. The authors refer throughout to ‘maternal-perinatal’ together as these conditions are closely linked and the interventions proposed will benefit both mothers and babies. The ‘perinatal period’ is the period during pregnancy, labour, delivery and during the first month after birth where a foetus or newborn is at risk of health complications.A call to action: five priority actionsThe authors argue that there are five priority areas which require immediate attention in order to meet Sustainable Development Goal 3.1:

1. Prioritise quality maternal-perinatal health services that respond to local contexts and meet emerging challenges. This action includes building linkages within and between maternal-perinatal and other health-care services
2. Promote equal, universal access to quality maternal-perinatal health services, including for the most vulnerable women. This action should seek to address the three major barriers women face when accessing care: gender inequality, physical lack of access due to remoteness or conflict, and financial constraints
3. Increase resilience and strength of health systems by making the best use of the health workforce (for example through investing in training and retaining the workforce, as well as redistributing health care workers equally across geographical areas) and improving each facility’s ability to provide quality care
4. Guarantee sustainable funding for maternal-perinatal health. This action involves funding from governments in low- and middle-income countries as well as international donors. The authors recommend that governments increase investments in their population’s health in line with increases in their country’s wealth, and that international donors direct their financial assistance specifically towards vulnerable populations. Overall, all partners should ensure that they efficiently allocate resources to maternal health
5. Accelerate progress through evidence, advocacy, and accountability, including redefining maternal-perinatal health measures, conducting implementation research to identify priorities, and translating evidence into action

The authors call on all stakeholders to work together to tackle these actions. They argue that national and local governments must be supported by development partners, civil society, and the private sector in leading efforts to improve maternal health. These priority actions will also require strong partnerships between the maternal health community and those working on other health issues. Achieving these actions will benefit women, newborn babies, and prevent stillbirths, and those gains will in turn benefit children, families, and the community, in this generation and the next.To read the original article for free after registering, click here.To view an infographic on maternal mortality targets by MamaYe and Ending Preventable Maternal Mortality, click here.Koblinsky, M., Moyer, C., Calvert, C., Campbell, J., Campbell, O., Feigl, A., Graham, W., Hatt, L., Hodgins, S., Matthews, Z., McDougall, L., Moran, A., Nandakumar, A., & Langer, A. (2016). Quality maternity care for every woman, everywhere: a call to action. The Lancet Maternal Health Series Paper 6, (Early online publication).